Fever and Severe Headache in a Young Man

Fever and Severe Headache in a Young Man

A 28-year-old man presents to
the emergency department
with high fever; progressive, severe,
generalized, throbbing headache;
blurred vision; and increasing
confusion. These symptoms started
3 days earlier.

History. The patient had previously
been healthy and active; he
works in the oil fields. He is married
and does not smoke, drink alcohol,
or use illicit drugs. He has had no
blood transfusions and takes no
medications.

Examination. This well-built man
appears ill. Pulse rate is 110 beats per
minute; temperature, 38.3C (101F);
respiration rate, 22 breaths per minute;
blood pressure, 116/72 mm Hg.
He is well hydrated. No scleral icterus
or oral candidal infection. Pupils are
equal and reactive. No palpable adenopathy
or rashes. The patient is confused;
disoriented to person, time,
and place; and agitated. Cranial nerves
are intact. Fundi are normal. He can move all his limbs.
Deep tendon reflexes are normal; plantar reflexes are
equivocal. Neck is supple. Remainder of the examination is
normal.

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